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Atrophoderma of Pasini and Pierini Treatment & Management

  • Author: Sarah Jane Adams, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Apr 11, 2016
 

Medical Care

No treatment is consistently effective, but some patients respond to topical corticosteroids, antibiotics, or antimalarials.

Results of medical treatment with antibiotics have been inconclusive. In patients with new early-stage idiopathic atrophoderma of Pasini and Pierini, especially those with a positive B burgdorferi antibody titer, the standard recommended therapy for Lyme disease is suggested. A retrospective evaluation of 25 patients treated with oral penicillin (2 million IU/d) or oral tetracycline (500 mg 3 times/d) for 2-3 weeks showed clinical improvement with no new active lesions in 20 patients. The same study also showed no progressive disease in 4 of 6 patients who did not receive treatment.

A report of a 35-year-old woman with elevated B burgdorferi antibody (IgM) titer and atrophoderma of Pasini and Pierini describes clinical improvement with no new lesions with doxycycline (200 mg/d) for 6 weeks.[19]

Anecdotal reports have described beneficial treatment with the use of hydroxychloroquine[20] and potassium aminobenzoate.

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Surgical Care

Surgical treatment has generally not been helpful in improving the appearance of the atrophied skin.

Arpey et al[21] showed the Q-switched alexandrite laser (755 nm) to be effective in diminishing the hyperpigmentation by 50% after 3 treatments in one case.

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Complications

Idiopathic atrophoderma of Pasini and Pierini is typically a benign, asymptomatic condition; no complications have been reported.

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Long-Term Monitoring

Once the diagnosis is established, outpatient care consists of following up for the development of new lesions and the involvement of new areas. Ultrasonography may be used for diagnosis and follow-up.

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Contributor Information and Disclosures
Author

Sarah Jane Adams, MD Resident Physician, Department of Dermatology, Northwestern University, The Feinberg School of Medicine

Sarah Jane Adams, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Womens Association, Chicago Dermatological Society, Society for Melanoma Research

Disclosure: Nothing to disclose.

Coauthor(s)

Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD Professor of Dermatology, Chief of General Dermatology, Director of the Collagen Vascular Disorders Clinic, Northwestern University, The Feinberg School of Medicine

Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD is a member of the following medical societies: American Academy of Dermatology, Association of Professors of Dermatology, British Association of Dermatologists, Chicago Dermatological Society, Chicago Medical Society, Illinois Dermatological Society, Illinois State Medical Society, Medical Dermatology Society, Society for Investigative Dermatology, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Pranathi Lingam, MD Resident Physician, Department of Dermatology, University of Michigan Medical School

Disclosure: Nothing to disclose.

Acknowledgements

Peter Fritsch, MD Chair, Department of Dermatology and Venereology, University of Innsbruck, Austria

Peter Fritsch, MD is a member of the following medical societies: American Dermatological Association, International Society of Pediatric Dermatology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Richard H Musgnug, MD Former Assistant Clinical Professor, Department of Dermatology, Thomas Jefferson Medical School, Virtua Memorial Hospital, Cooper Medical Center

Disclosure: Nothing to disclose.

Neelam Vashi, MD Resident Physician, Department of Dermatology, New York University Medical Center

Neelam Vashi, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Physicians of Indian Origin, American Medical Association, and Indian American Medical Association

Disclosure: Nothing to disclose.

References
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  2. Pierini L, Vivoli D. Atrofodermia progressiva (Pasini). G Ital Dermatol. 1936. 77:403-09.

  3. Canizares O, Sachs PM, Jaimovich L, Torres VM. Idiopathic atrophoderma of Pasini and Pierini. AMA Arch Derm. 1958 Jan. 77(1):42-58; discussion 58-60. [Medline].

  4. Yokoyama Y, Akimoto S, Ishikawa O. Disaccharide analysis of skin glycosaminoglycans in atrophoderma of Pasini and Pierini. Clin Exp Dermatol. 2000 Jul. 25(5):436-40. [Medline].

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  9. Avancini J, Valente NY, Romiti R. Generalized lenticular atrophoderma of Pasini and Pierini. Pediatr Dermatol. 2015 May-Jun. 32 (3):389-91. [Medline].

  10. Saleh Z, Abbas O, Dahdah MJ, Kibbi AG, Zaynoun S, Ghosn S. Atrophoderma of Pasini and Pierini: a clinical and histopathological study. J Cutan Pathol. 2008 Dec. 35(12):1108-14. [Medline].

  11. Miteva L, Kadurina M. Unilateral idiopathic atrophoderma of Pasini and Pierini. Int J Dermatol. Nov 2006. 45(11):1391-3. [Medline].

  12. Buechner SA, Rufli T. Atrophoderma of Pasini and Pierini. Clinical and histopathologic findings and antibodies to Borrelia burgdorferi in thirty-four patients. J Am Acad Dermatol. 1994 Mar. 30 (3):441-6. [Medline].

  13. Lis-Święty A, Bierzyńska-Macyszyn G, Arasiewicz H, Brzezińska-Wcisło L. Bilateral atrophoderma linearis: a relationship between atrophoderma linearis Moulin and atrophoderma Pasini-Pierini?. Int J Dermatol. 2016 Mar. 55 (3):339-41. [Medline]. [Full Text].

  14. Batista CM, Lemos MO, Franceschi LE, Basilio CB, Reis CM. Case for diagnosis. An Bras Dermatol. 2014 Jul-Aug. 89 (4):671-3. [Medline].

  15. Kopec-Medrek M, Kotulska A, Zycinska-Debska E, Widuchowska M, Kucharz EJ. Exacerbated course of atrophoderma of Pasini and Pierini in patient with papillary cancer of the thyroid gland. Wiad Lek. 2010. 63(1):24-6. [Medline].

  16. Abe I, Ochiai T, Kawamura A, Muto R, Hirano Y, Ogawa M. Progressive idiopathic atrophoderma of Pasini and Pierini: the evaluation of cutaneous atrophy by 13-MHz B-mode ultrasound scanning method. Clin Exp Dermatol. 2006 May. 31(3):462-4. [Medline].

  17. Berman A, Berman GD, Winkelmann RK. Atrophoderma (Pasini-Pierini). Findings on direct immunofluorescent, monoclonal antibody, and ultrastructural studies. Int J Dermatol. 1988 Sep. 27 (7):487-90. [Medline].

  18. Kernohan NM, Stankler L, Sewell HF. Atrophoderma of Pasini and Pierini. An immunopathologic case study. Am J Clin Pathol. 1992 Jan. 97(1):63-8. [Medline].

  19. Lee Y, Oh Y, Ahn SY, Park HY, Choi EH. A Case of Atrophoderma of Pasini and Pierini Associated with Borrelia burgdorferi Infection Successfully Treated with Oral Doxycycline. Ann Dermatol. 2011 Aug. 23(3):352-6. [Medline]. [Full Text].

  20. Carter JD, Valeriano J, Vasey FB. Hydroxychloroquine as a treatment for atrophoderma of Pasini and Pierini. Int J Dermatol. 2006 Oct. 45(10):1255-6. [Medline].

  21. Arpey CJ, Patel DS, Stone MS, Qiang-Shao J, Moore KC. Treatment of atrophoderma of Pasini and Pierini-associated hyperpigmentation with the Q-switched alexandrite laser: a clinical, histologic, and ultrastructural appraisal. Lasers Surg Med. 2000. 27(3):206-12. [Medline].

  22. Jeanselme E, Burnier R. Sclerodermie en plaques avec dyschromie pigmentaire symmetrique. Bull Soc Fr Dermatol Syph. 1926. 33:704-06.

  23. Per M. Oberflachliche, circumscripta Sclerodermie. Handbuch. 1931. 8:893.

 
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Early lesion demonstrating diagnostic "cliff-drop" border to atrophy. Courtesy of Joe Eastern, MD.
Older lesion showing typical pigmentation and classic "cliff-drop" border. Courtesy of Joe Eastern, MD.
Single ovoid patch of atrophoderma on the back of a young adult female.
Atrophic hyperpigmented patch with characteristic “cliff-drop” borders.
 
 
 
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